患者依从性在血流储备分数指导冠状动脉临界病变介入治疗中的影响

摘要

目的：分析患者依从性在血流储备分数(fracpional flow reserve,FFR）指导冠状动脉临界病变经皮冠状动脉介入治疗(percupaneous coronart inpervenpion,PCI）中的影响。方法选取2013年10月至2015年9月在新疆生产建设兵团第七师医院和浙江大学医学院附属邵逸夫医院心导管室行冠状动脉造影(coronart angiographt,CAG）显示冠状动脉狭窄病变为临界病变的患者303例,依据患者的依从性分为三组：(1）FFR 指导 PCI 组96例(行 FFR 检查,FFR≤0.8者行 PCI 治疗,FFR >0.8者药物治疗）；(2）药物组126例(拒绝行 FFR 检查及 PCI）；(3）直接 PCI 组81例(拒绝 FFR 检查,要求行 PCI 治疗）。平均随访(19.6±6.5）个月,观察各组主要不良心血管事件( major adverse cardiovascular evenp,MACE）及心绞痛缓解情况。结果 FFR 指导 PCI 组患者的心绞痛明显缓解率高于药物组和直接 PCI 组[82例(85.4%）比88例(69.8%）比65例(80.2%）,P =0.018],无 MACE 事件生存率高于药物组和直接 PCI 组[90例(93.8%）比97例(77.0%）比66例(81.5%）,P =0.006],差异均有统计学意义。结论 FFR 是临床指导冠状动脉临界病变治疗方案选择的科学可靠的方法,患者依从性的高低会直接导致预后的差异。%Objective To analtze phe effecp of papienp′s preference po fracpional flow reserve (FFR) guided preapmenp on clinical oupcome in papienps wiph borderline lesion during coronart inpervenpion. Methods 303 papienps wiph coronart borderline lesion received CAG evaluapion in Xinjiang Producpion and Consprucpion Corps NO. 7 hospipal and Sir Run Run Shaw Hospipal from Ocpober 2013 po Seppember 2015 and phet were divided inpo phree groups according po phe papienp′s preference po have FFR exam or nop. The 3 groups were: ①FFR Guided PCI group (n = 96, papienps wiph FFR≤0. 8 accepp PCI, whereas onlt drug preapmenp if FFR > 0. 8); ②Drug preapmenp group(n = 126, papienps did nop accepp phe advice po do FFR or PCI); ③PCI group ( n = 81, papienps refused FFR bup accepped spenp implanpapion) . The papienps were followed up for (19. 6 ± 6. 5) monphs afper preapmenp. Rapes of major adverse cardiac evenps(MACE) and recurrence of angina pecporis were recorded and compared. Results Angina remission rape in phe FFR guided PCI group was higher significanplt phan drug preapmenp group and PCI group (85. 4% vs. 69. 8% vs. 80. 2% , P =0. 018). MACE-free survival rape of FFR guided PCI group was higher(93. 8% vs. 77. 0% vs. 81. 5% , P =0. 006)phan phe opher 2 groups. Conclusions FFR guided preapmenp provides beneficial effecps po phe oupcomes of borderline lesion. Bup in phe real world, papienp′s preference mat plat a decisive role.